What’s the best way to manage neuropathy?
Despite many years of research, we still don’t have a good way to prevent or treat neuropathy.
Early clinical evidence suggests that using ice packs to cool certain nerves while receiving an infusion can shrink those blood vessels, reducing the blood flow to those areas — and, by extension, their exposure to the chemotherapy drugs.
But only one medication (duloxetine) has been included in the American Society of Clinical Oncology’s (ASCO) guidelines as a possible treatment for moderate to severe chemotherapy-induced neuropathy. It’s not routinely prescribed here at UT MD Anderson because only about 10-15% of affected patients might see some benefit from it.
Instead, we try to manage its symptoms, whether that’s through acupressure, acupuncture, scrambler therapy, peripheral nerve stimulation, red light therapy or some other form of therapy.
The reason we focus on managing neuropathy symptoms is that once nerves are damaged, they either recover or they’re gone for good. Whether we can reverse the damage depends on the kind and amount of chemo you’re using.
Is neuropathy curable?
Unfortunately, no. And, neuropathy is only reversible in about half the people who experience it. That doesn’t mean you won’t see any improvement at all if you develop it. It just means that many patients will live with at least some degree of neuropathy for the rest of their lives.
The good news is that we’re making significant strides now in the area of prevention. I just co-authored a research article, published in the journal Science, with 28 colleagues that explores this subject. In laboratory studies, we’ve found that psilocybin, a compound found in fungi, can help protect nerves from chemotherapy’s more negative effects.
One of the ways chemotherapy damages a nerve is by disrupting its mitochondria, the power plants of our cells. If the mitochondria can’t manufacture enough energy, the nerves start to shrink and die. But we’ve found that just a few doses of psilocybin given before chemotherapy can make the nerve cells more resilient, so they never get into an energy crisis.
We just opened a new clinical trial to study this compound further and see what other protective benefits it might have. Regenerating or reviving damaged nerves is almost impossible using today’s technology. That’s why we’re focusing on prevention.
Moran Amit, M.D., Ph.D., is a surgeon and researcher who specializes in treating head and neck cancers.
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